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Why Are More Children With T1DM Experiencing DKA at Diagnosis?

T1DM Experiencing DKA at Diagnosis

(HealthDay News) — A growing number of American children and teens with type 1 diabetes are experiencing diabetic ketoacidosis (DKA) at the time of their diagnosis, according to research published in the April 21 issue of the Journal of the American Medical Association, a theme issue on child health.

Arleta Rewers, MD, from the University of Colorado School of Medicine in Aurora, and colleagues looked at the medical records of 3,439 patients aged <18 in Colorado who were diagnosed with type 1 diabetes between 1998–2012. The authors found that 39% of the children had DKA at the time of their diagnosis. What's more, there was a 55% increase in the rate of patients with the complication at the time of diagnosis during the study period – from 30% in 1998 to 46% in 2012.

The only patient characteristic that changed over the study period was insurance, with those covered by public insurance rising from 17.1% in 2007 to 37.5% in 2012. The researchers also found that younger and black patients were more likely to have DKA, while having private insurance and a history of a close relative with type 1 diabetes was associated with a lower risk.

The findings suggest that a growing number of American youth with type 1 diabetes may be faced with delays in diagnosis and treatment, Rewers' team said. In fact, the current rate of DKA found in the study is similar to rates in countries with poor access to health care, and much higher than rates in Canada or the United Kingdom. "Increasing incidence of DKA correlated temporally with an increase in Colorado child poverty prevalence from 10% in 2000 to 18% in 2012," Rewers' group writes, adding that "the recent increase of DKA incidence among youth with private insurance may be related to proliferation of high-deductible health plans."